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ZA - Respiratory Diseases > COPD > Flashcards

COPD Flashcards

1
Q

What is COPD? Give features

A

Chronic Obstructive Pulmonary Disease

A SLOW progressive disease with little variation
(AFO that doesn’t change markedly over several months)

Most lung function impairment is fixed and irreversible

Made of emphysema and chronic bronchitis

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2
Q

What is emphysema? How is elasticity lost?

A

Hyperinflation of lung, destruction of lung tissue and elasticity with minimal fibrosis
Elasticity is lost by loss of alveolar attachments

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3
Q

What causes the AFO in COPD?

A

Excretions of mucus and exudates cause AFO

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4
Q

What is the aetiology of COPD?

A

Chronic asthma
Smoking
Occupational
Alpha1-antitrypsin deficieny

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5
Q

Do you have to be a smoker to get COPD?

A

No, can occur in people with antitrypsin deficiency or those who develop it from chronic asthma

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6
Q

What is alpha1-antitrypsin’s role?

A

Neutralises enzymes released by n.phils that destroy elastic tissue

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7
Q

What is a typical COPD patient? Age? Symptoms?

A

+40s
Smoker/Ex-Smoker
Dyspnoea of exertion
Cough - productive

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8
Q

What should be asked in a history?

A

PMH - Asthma as a child, any other resp diseases, ischaemic heart disease

Drugs - any inhalers and doses, previous meds and affects they had on breathing

Personal and social - Occupation, smoker

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9
Q

How are pack years calculated?

A

Packs smoked a day x years smoked

60 cigs a day (3 packs) x 23 years

= 69 pack years (so unintentional)

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10
Q

Symptoms of COPD?

A

Dyspnoea on exertion
Cough and sputum
Wheeze on exertion
Weight loss - indicator of severe disease
Peripheral oedema - indicator of severe disease and/or resp failure/ cor pulmonale

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11
Q

Signs on examination?

A 
Pursed lip breathing
Use of accessory muscles
Hyperextended barrel chest - reduced exapnsion
CO2 flap
Cyanosis
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12
Q

What are some signs of cor pulmonale?

A

Increased JVP
Hepatomegaly (enlarged liver)
Ascities
Oedema

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13
Q

What investigations can be done?

A 
Spirometry
Full pulmonary testing
Response to bronchodilators and ICSs
CxR
ECG
Arterial blood gases
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14
Q

What will be seen in a spirometry test?

A

FEV1:FVC <70%
FEV1 <80%

If its normal rules out COPD

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15
Q

Why is full pulmonary testing done?

A

To look for presence and extent of emphysema

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16
Q

Why is patients response to ICSs and Bronchodilators tested?

A

If reversibility is shown - could be asthma

17
Q

What will a CxR show up if it is COPD?

A

Hyperinflated lungs/chest
Flattened Diagrams
Bullae

18
Q

What will an ECG show?

A

RA and RV hypertrophy - test for cor pulmonale

19
Q

Why do a blood gas test?

A

Low PaO2 shows hypercapnea

20
Q

Severity of COPD - Mild?

A

FEV1 still normal - above 80% but symptoms are getting worse, beginning of COPD

21
Q

Moderate?

A

FEV1 - 50 - 79%

22
Q

Severe?

A

FEV1 30-49%

23
Q

Very severe?

A

FEV1 is less than 30%

24
Q

What is some non-pharmalogical measures to manage COPD?

A

Smoking cessation
Pulmonary rehab
Vaccines
Long term O2 therapy

25
Q

What does pulmonary rehab and vaccines do to help?

A

Rehab prevents exacerbation of problems

Vaccines prevent infective exacerbations

26
Q

What is the stepped approach treatment for COPD?

A

1 - SABA/SAMAs

2 - long acting bronchodilators = LABA (with ICS) or LAMA

3 - Triple therapy = ICS, LAMA and LABA all together

27
Q

What is SABA?

A

Short acting beta 2 agonist - salbutamol

28
Q

What is SAMA?

A

Ipratropium

Short acting muscurinic antagonists -

29
Q

What is a LABA?

A

Salmeterol

Long acting b2 agonist - should always be given with a ICS

30
Q

What is LAMA?

A

Tioptropium

Long acting muscurinic antagonist

31
Q

What is in a high dose LABA/ICS combination inhaler

A

Relvar/Fostair

32
Q

What is acute exacerbation of COPD precipitated by?

A

Infections
Sedatives
Pnemothorax
Trauma

33
Q

How does acute COPD present?

A

Just as an exacerbation of symptoms

34
Q

Investigations of acute COPD?

A 
CxR
Blood gases
FBC
Us and Es
Sputum culture

Want to isolate a cause - infection or otherwise

35
Q

Treatment for acute COPD?

A

Nebulised SABA/SAMA
Oral steroids - prednisolone
Antibiotics to treat an infection if present

ZA - Respiratory Diseases (30 decks)

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